摘要
目的探讨床旁肺部超声（bedside lung ultrasound，BLU）用于重症患者机械通气（mechanical ventilation，MV）脱机评估的价值，尤其是动态监测MV治疗患者的肺部病变及膈肌功能变化的意义。方法前瞻性选取2016—03～2016—09人住我院重症医学科（intensive careunit，ICU）符合纳入条件的28例MV患者。进入自主呼吸实验流程15min后，具有资质的ICU医师使用BLU评估患者肺部及膈肌功能等指标，以帮助指导脱机流程。结果①本研究的脱机成功率为89．29％（25／28）。3例患者因呼吸机相关膈肌功能障碍造成脱机困难，其中2例因自动出院而死亡，1例患者经治疗后延时脱机。②膈肌功能（膈肌活动度、膈肌厚度及膈肌增厚率）与浅快呼吸指数、通气时间存在负相关关系（P〈0．05），与APACHEII评分、年龄等因素不存在相关关系（P〉0．05）。结论MV时间长短与膈肌功能损伤程度密切相关。呼吸机相关膈肌功能障碍的发生可增加MV患者的呼吸机治疗时间和病死率。BLU与浅快呼吸指数等指标联合应用可有效指导重症MV患者脱机评估流程。
Objective To investigate the value of bedside lung ultrasound （BLU） in the weaning from mechanical ventilation（MV） in ICU patients, especially the dynamic monitoring changes of pulmonary lesions and diaphragmatic function. Methods We prospectively selected 28 cases of mechanically ventilated patients in accordance with the inclusion criteria from March 2016 to September 2016. At the beginning of the spontaneous breathing test after fifteen minutes, the authorized ICU doctors assessed indicators of pulmonary lesions and diaphragmatic function in mechanically ventilated patients by BLU, to help guide the weaning process. Results ①In this study, the success rate of weaning was 89.29% （25/28）. The 3 cases of weaning failure were closely related to ventilator - induced diaphragmatic dysfunction; 2 cases died after discharged without treatment; and 1 case survived after treatment. ②Diaphragmatic function （diaphragm excursion, the thickness of the diaphragm and diaphragm thickening fraction） had significant negative correlation with rapid shallow breathing index and the duration of ventilation （ P 〈 0.05 ）. There was no obvious correlation between the APACHE II score, age and other factors （P 〉 0.05）. Conclusion This study indicated that the duration of MV is closely related to the degree of diaphragmatic function injury. Ventilator - induced diaphragmatic dysfunction significantly increases the duration of ventilation and mortality in mechanically ventilated patients. The combination of BLU and rapid shallow breathing index can effectively guide the evaluation of weaning process in mechanically ventilated patients.
出处
《中国急救医学》
CAS
CSCD
北大核心
2017年第11期1000-1004,共5页
Chinese Journal of Critical Care Medicine
基金
2017年国自然青年研究基金（81601661）
安徽省自然科学基金面上项目（1608085MH195）
